The HHS Solution

I’m thrilled that the Obama administration has revised the HHS regulations to address the concerns of Catholic affiliated organizations.

The Catholic Health Association has weighed in supporting the solution. “We are very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions. The framework developed has responded to the issues we identified that needed to be fixed.” This recalls Sr. Carol’s previous forthright statement that “something needs to be fixed.”

The details of the solution are very important. They manifest great attention to the nuances of Catholic moral reasoning. As described by the Administration, this is a very substantial solution that is enormously attentive to the details of Catholic moral understanding over cooperation in immoral acts. This is much better than the “Hawaii” option.

1. It completely insulates religious employers from any payment for coverage of contraception. The details are tremendously important here. As described by the Administration, the regulation is based on a different portion of the Affordable Care Act that allows HHS to mandate coverage that does not increase costs to insurance companies. This requires an actuarial finding that it costs insurance companies less to provide contraception than it does to pay for unplanned pregnancies and the complications that arise from them. Thus, there is no additional cost. For that reason, it cannot be said this requires objecting employers to pay for coverage covertly. There is no additional cost to be paid. If this is the structure, there would be no cooperation here at all. This moves us completely out of the realm of moral cooperation. The importance of this structure can’t be understated. I worry greatly that it will be ignored in the current heated rhetorical environment.

2. It avoids the requirement, implemented in Hawaii and the previous HHS regulation, that objecting employers post announcements directing employees to providers of contraceptive services. This again shows attention to Catholic moral calculus that few outside the Church are even aware of, let alone respect. Ethicists at Catholic heath organizations told me they could not easily comply with that, as it would constitute cooperation. Again, as described by the administration, this does away with that very real quandary for Catholic organizations, that few are aware of, let alone understand. Most people would say, “You can’t even include a flyer in your benefits handouts?” The Administration has shown its concern for the hair-splitting details of the Catholic moral tradition.

The solution the Administration has offered displays the care and attentiveness that their substantial investment in relationships with the Catholic faith community made possible all along. That fact only deepened my disappointment in the previous HHS regulations. They have corrected their unforced error.

The details of this solution matter. There may yet be important moral snags that emerge with the details when the new regulation is published. I hope that the USCCB switches from the broad-brush culture war denunciations that have marked their (understandably forceful) response so far. In its proffered solution, the Obama Administration has spoken to the details of our tradition. The Church is all the more obliged to speak with our native precision in its response.

Comments

Marie Rehbein | 2/11/2012 - 5:55pm

Josh, just because insurance has worked a certain way does not mean it continues to work that way after the health insurance reform. When has it ever been the case that insurers contacted individuals separately from their employers in order to provide an insurance product? This is new ground being broken. Where will the insurers find the money to cover the"free to the insured" contraceptives? If they have to, they will find it outside of the group they insure if that group cannot stomach providing contraception for moral reasons. In most cases these days, employees themselves contribute something. It would surprise me if the cost of contraceptives in any group was greater than the premium contributions coming from the non-Catholic employees. That does not mean, however, that this is necessarily how it's being figured.

As to John Garvey: anyone who begins his presentation with the idea that pregnancy has to be considered a disease in order for someone to want to prevent it, clearly has a very narrow perspective on the matter. There are all manner of ailments that result from pregnancy, but many men, particularly those educated by the Catholic Church, seem to believe that because it is natural for women to become pregnant and bear children there is never any justifiable reason to prevent it. They are wrong. Furthermore, some contraceptive products have broader uses than pregnancy prevention.

Josh,The money comes from premiums. OK. However, the Catholic Church affiliated institutions are putting their money in a pot. There is no direct relationship between a premium and any particular claim that gets paid. The bishops were not objecting to putting the money in the pot. They didn't want to be associated with a policy that explicitly provides contraception. Only the most extreme right-wing Catholics are claiming that putting money in a pot taints them.

Since some didn't like Megan McArdle saying it, here's Ezra Klein's blog on the Washington post:

"The catch here is that there’s a difference between “revenue neutral” and “free.” By one report’s measure, it costs about $21.40 to add birth control, IUDs and other contraceptives to an insurance plan. Those costs may be offset by a reduction in pregnancies. But unless drug manufacturers decide to start handing out free contraceptives, the money to buy them will have to come from somewhere.Where will it come from, since neither employers nor employees will be paying for these contraceptives? That leaves the insurers, whose revenues come from the premiums that subscribers pay them. It’s difficult to see how insurance companies would avoid using premiums to cover the costs of contraceptives. They could, perhaps, use premiums from non-religious employers. Those businesses wouldn’t likely object on faith-based grounds, but they probably wouldn’t be keen on footing the bill for people who aren’t on their payrolls."

I get that Progressive Catholics just this whole mess to go away, but to accept an accounting gimmick as a serious victory without questioning the mechanics strikes me as weak. I also commend CUA President Garvey & Mary Ann Glendon's letter.

David, the Church only pays for it because money circulates. Money that once was in the possession of the Church will be in someone else's possession at some point and might be attributable to a contraceptive purchase. Again the Church related institutions are free to decline to participate in insurance.

I am looking forward to the day when those who consider pork consumption sinful begin to insist that foodstamps cannot be used to buy pork because they pay taxes and some of their taxes go toward providing foodstamps. It's the same thing.

The idea that contraception should not be paid for by insurers has not been the bishop's point, however. Presumably the mandate that they provide insurance that pays for contraception was the problem. Since they will now be providing insurance that does not pay for contraception, and contraception will be paid separately in an arrangement between the insurer and the patient, there should be no more problem, at all.

My pointing out Ms. McArdle's lack of expertise was my way of pointing out her failure to see the obvious facts of the dispute. That has to be attributable to something.

Megan McArdle is a senior editor for The Atlantic who writes about business and economics. She has worked at three start-ups, a consulting firm, an investment bank, a disaster recovery firm at Ground Zero, and The Economist, and she holds a bachelor's degree in English literature from the University of Pennsylvania and an M.B.A. from the University of Chicago.

In short, Megan McArdle has no experience in the insurance industry, unlike Kathleen Sebelius, who from 1995 to 2003 served as Kansas Insurance Commissioner. I think someone who was an insurance commissioner probably has a better understanding of how insurance companies work out their costs than a magazine editor does.

Talk about moving goal posts... The USCCB lawyer says that if he opens a Taco Bell he should not have to pay for BC for his employees because he is a Catholic. Of course the $8 dollar an hour empoyees don't have any insurance.. Now that's moving the goal posts. no BC on no insurance. easy for all..

Marie - I dont think your description of the "pot" (nor of those like John Garvey as "extreme right-wing") is accurate. Of. Course when my employer pays the premiums for my (and my co-workers) health insurance it goes into a "pot" for claims from that same group.But it is not accurate to say that un-spent funds from that group plan are then taken the insurance company and used to cover other services for another set of claimants. That would some bizarre accounting, and would of course leave no profit for the insurance company.

Yes, some sleep and clear-headed reasoning might be just the thing David..

If the policies are higher than similarly situated non-Catholic institution employers than please do share this information with us.

BTW, I don't think the Obama Administration necessarily had to make this adjustment and neither do a majority of American Catholics polled the other day. I do think we need a single payer health care system like Canada's and I would support re-visiting the practice of pouring public $$ into religious institutions that discriminate and then cry foul.

"In short, Megan McArdle has no experience in the insurance industry, unlike Kathleen Sebelius, who from 1995 to 2003 served as Kansas Insurance Commissioner. I think someone who was an insurance commissioner probably has a better understanding of how insurance companies work out their costs than a magazine editor does."

She has forgotten more about health reform than most ever know; you might disagree with her, but to say she doesn't know what she's talking about is naive.

At least one non-Catholic observer (Megan McArdle at the Atlantic) says the compromise still requires the Church-institutions to pay for the services:

''Update: Commenters point out that I've misread it-the insurers have to provide it ''at no cost''. Which of course means the Church will still be paying for it. So the question is, how do the Catholics take it?''